PRIYA DIAZ
Subscriber on policy B02M000013
Claims
3
Attributed to this person
Charged
963.00
Total submitted
Denied
442.00
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | PRIYA DIAZ |
| Role on the policy | Subscriber |
| Policy | B02M000013 |
| Date of birth | 16 Sep 1995 |
| Plan | SILVER HMO |
| Covered from | 5 Nov 2024 |
| Covered to | 29 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000086 | 15 Jun 2025 | 442.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 442.00 |
| CLM0000085 | 9 Apr 2025 | 299.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000087 | 24 Dec 2024 | 222.00 | NORTHSTAR MUTUAL | Not denied | — |